System and method for distributing meaningful clinical alerts

ABSTRACT

A messaging system ( 100 ) for routing clinical messages includes an event handler and a standardized protocol ( 105 ). The event handler ( 106 ) receives one or more inbound messages from one or more event sources ( 102 ). The event sources ( 102 ) include one or more worklist items. The event handler ( 106 ) further stores the worklist items in an event database ( 198 ) and generates and communicates outbound messages for one or more worklist items in the event database ( 198 ) that need to be acted upon, as determined by one or more rules. The standardized protocol ( 105 ) is used to represent the inbound messages and the outbound messages.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a national filing of PCT application Serial No.PCT/IB2011/055858, filed Dec. 21, 2011, published as WO 2012/093307 A1on Jul. 12, 2012, which claims the benefit of U.S. provisionalapplication Ser. No. 61/532,835 filed Sep. 9, 2011 and U.S. provisionalapplication Ser. No. 61/429,779 filed Jan. 5, 2011, both of which areincorporated herein by reference.

The present application relates generally to electronic communications.It finds particular application in routing alerts and messages toclinicians, and will be described with particular reference thereto.However, it is to be understood that it also finds application in otherusage scenarios, and is not necessarily limited to the aforementionedapplication. For example, it finds application in manufacturing, fire,security and other industries.

Clinical decision support applications often deliver generic alertsand/or alerts specific to end devices. For example, monitoring systemsmay generate generic alerts if a parameter reaches a certain threshold.However, one problem with delivering generic alerts and/or alertsspecific to end devices is that such alerts fail to target specificclinicians.

Failing to target specific clinicians often leads to alerts reachingdisinterested clinicians or never reaching a clinician who can act uponthe content of the alert. For example, a clinician may receive an alertthat does not pertain to their clinical role and/or their patient list.Other examples include a clinician receiving an alert while they are offduty and/or unavailable or the alert being sent to a device theclinician is carrying which is physically turned off and/or out ofcommunication range.

Additionally, clinical decision support applications often deliveralerts regardless of their temporal relationship to a workflow and/orthe urgency for a patient. For example, an alert indicating a need for aPneumovax vaccine prior to hospital discharge is temporally premature ata time when the critically ill patient is arriving in an Intensive CareUnit (ICU).

Addressing some of these concerns, there are messaging systems whichsend alerts to devices and include business logic to take action whentarget devices fail to acknowledge the alerts. However, these systemsmust typically be configured for each alert and/or user, which is laborintensive, or are generic based on one or more of event source, userrole, and notification device. Furthermore, they do not provide fordynamic and/or complex business logic that is based on worklists for agiven user and/or patient.

Moreover, messaging systems often lead to less critical alerts reachingclinicians following critical alerts that occupy the clinicians' time.This can be distracting to the clinicians servicing more severe alerts.Also, messaging systems typically wait a predetermined period of timefor a clinician to accept an alert before alerting another clinician.This can increases the amount of time it takes to service the lesssevere alerts since these alerts are not likely to be rejected and theescalation time must generally lapse.

The present application provides a new and improved system and methodfor routing alerts and other messages to clinicians, which overcomes theabove-referenced problems and others.

In accordance with one aspect, a messaging system for routing clinicalmessages is provided. The system includes an event handler and astandardized protocol. The event handler receives one or more inboundmessages from one or more event sources. The messages include one ormore worklist items. The event handler further stores the worklist itemsin an event database and generates and communicates outbound messagesfor one or more worklist items in the event database that need to beacted upon, as determined by one or more rules. The standardizedprotocol is used to represent the inbound messages and the outboundmessages.

In accordance with another aspect, a method of routing clinical messagesis provided. One or more inbound messages in a standardized protocol arereceived from one or more event sources. The inbound messages includeone or more worklist items. The worklist items are stored in an eventdatabase and outbound messages in the standardized protocol aregenerated and communicated for one or more worklist items in the eventdatabase that need to be acted upon, as determined by one or more rules.

In accordance with another aspect, a method of self describing andcommunicating event information to an event handler is provided. Anevent notice is received and a message using a standardized protocol isgenerated. The messages includes event information and one or moreworklist items, represented using one or more standardized messageproperties. The worklist items specify to whom the message is directedand how the message should be routed by the event handler.

In accordance with another aspect, a worklist is maintained per patientand per user. The worklist keeps track of active alerts awaitingresponse, active work items, and future or scheduled worklist items. Theworklist enables the system to prioritize and redirect workflow based onseverity of incoming tasks or alerts for a given patient and usercontext.

In accordance with another aspect, a standardized protocol is utilizedto establish desired business logic for routing a message. This allowssystems that utilize this protocol to establish a mechanism for anexternal system to pass the message with an end user context as part ofthe message and have the end user response passed back to the messagingapplication, without the application needing to know anything about theend user's status or preferences.

One advantage of the present system and method is that it deliversmessages in an intelligent manner.

Another advantage resides in the ability to route alerts and/or messagesto specific users and clinical roles.

Another advantage resides in the ability to specify a next escalationstep for an alert and/or message within the alert and/or message.

Another advantage resides in the ability keep track of the status ofvarious pending alerts, work tasks, and/or messages.

Another advantage resides in the ability for a consolidated workflow tobe supported from a multitude of different systems active for the useror patient.

Another advantage resides in the ability to implement alert and/ormessage handling rules in a flexible manner, by processing messagescompliant with self-describing protocols and by permitting specificbusiness rules locally for systems which do not use the protocol.

Another advantage resides in the ability to define complex escalationsteps for alerts and/or messages.

Another advantage resides in the ability to provide user acknowledgmentand responses selection outside the native application, and have theresponses passed back to the alerting application.

Another advantage resides in the ability to represent escalation stepsfor alerts and/or messages in a standardized manner.

Another advantage resides in that events are accepted and serviced morequickly.

Another advantage resides in that alarm fatigue and distraction on thepart of the staff is reduced.

Another advantage resides in improved safety.

Still further advantages of the present invention will be appreciated tothose of ordinary skill in the art upon reading and understand thefollowing detailed description.

The invention may take form in various components and arrangements ofcomponents, and in various steps and arrangements of steps. The drawingsare only for purposes of illustrating the preferred embodiments and arenot to be construed as limiting the invention.

FIG. 1 provides an overview of a messaging system according to aspectsof the present disclosure;

FIG. 2 is a detailed block diagram of the messaging system of FIG. 1;

FIG. 3 is a block diagram of an event handler according to aspects ofthe present disclosure;

FIG. 4 is an event message according to aspects of the presentdisclosure;

FIG. 5 is a block diagram for a method of routing clinical messages;

FIG. 6 is a block diagram for a method of escalating work list itemsbased on target availability; and,

FIG. 7 is a block diagram for a method of self describing andcommunicating event information.

With reference to FIG. 1, in one embodiment, a messaging system 100includes one or more event source interfaces 104 to one or more eventsources 102, an event handler 106, a message service interface 108 to amessage service 110 that communicates with one or more event targets112, and the like.

The event sources 102 generate event messages in response to clinicalevents and communicate the event messages to the event handler 106.Clinical events include one or more of physiological events, such asdetection of low potassium in patients, notification of workflow items,such as a medication administration is due or overdue, system events,such as a redundant array of independent disks (RAID) failures, and thelike.

The event messages include information pertaining to the associatedclinical event that a clinician would find pertinent. For example, anevent message generated in response to a blood pressure alert for apatient includes the blood pressure of the patient. Each of the eventmessages include one or more worklist items and one or more of a uniqueevent identifier, capabilities, event properties, time properties,source properties, target properties, acknowledgement properties, andthe like, discussed in detail below. A worklist item is an action to beperformed in response to an event. The event messages are communicatedin one or more of a one-way mode, a two-way mode, or the like. Messagescommunicated in the one-way mode do not require responses; whereas,messages communicated in the two-way mode require responses. In certainembodiments, responses can be used by the event sources 102 to triggeractions in the event sources 102.

In some embodiments, a distinction is made between one-way event sourcesand two-way event sources. One-way event sources include the ability tosend messages, but not receive messages; and, two-way event sourcesinclude the ability to send and receive messages, such as a userresponse to an alert. Thus, two-way event sources send one-way messagesand/or two-way messages and receive messages; whereas, one-way eventsources only send one-way messages.

Additionally or alternatively, in some embodiments, a distinction is bemade between subscribed event sources and unsubscribed event sources.Subscribed events sources support a standardized protocol 105 understoodby the event handler 106, by which they communicate directly with theevent handler 106. Unsubscribed event sources, in contrast to subscribedevent sources, lack support for the standardized protocol 105 understoodby the event handler 106, whereby they communicate indirectly with theevent handler 106.

The event source interfaces 104 bridge communications betweenunsubscribed event sources and the event handler 106. The event sourceinterfaces 104 receive messages sent from the unsubscribed event sourcesto the event handler 106, reformat the messages into the standardizedprotocol 105 supported by the event handler 106, and forward thereformatted messages to the event handler 106. Further, the event sourceinterfaces 104 receive messages sent in the standardized protocol 105from the event handler 106 to the unsubscribed event sources, reformatthe messages into a format accepted by the unsubscribed event sources,and forward the reformatted messages to the unsubscribed event sources.

The event source interfaces 104 suitably include a single event sourceinterface for all unsubscribed event sources, an interface for or builtinto each unsubscribed event source, or the like. However, otherconfigurations are contemplated. For example, an event source interfaceis employed for each type of unsubscribed event source (e.g., a PhilipsIntellivue™ monitor MX800).

The event source interfaces 104 advantageously ensure interoperabilitybetween the event sources 102 and the event handler 106. However,because the event source interfaces 104 need not be used by subscribedevent sources and the messages sent in the standardized protocol 105ensure interoperability, the messaging system 100 need not include theevent source interfaces 104 when the messaging system 100 onlycommunicates with subscribed event sources.

The event handler 106 receives inbound messages, such as event messagesand/or response messages, from the event sources 102 and/or the eventtargets 112, and communicates outbound messages, such as escalationmessages and/or event handler response messages, corresponding to theinbound messages to targets and the like. Inbound event messages fromthe event sources 102 suitably yield outbound escalation messages to theevent targets 112 of the event messages, and inbound response messagesfrom the event targets 112 suitably yield outbound event handlerresponse messages to the event sources 102.

Upon receipt of an inbound message, the event handler 106 suitablyverifies and, possibly, modifies the inbound message using one or morerules. A rule suitably includes a match criteria and a match action,which is carried out if the match criteria is met. The match actionincludes, for example, modifying the inbound message. The match actionand/or the match criteria can take into account one or more of hospitalpolicies, target settings, properties of the inbound message, on-callstatus, worklists, workflows, other events, and the like.

Further, upon receipt of the inbound message, the event handler 106suitably adds the inbound message, with any modifications that may havebeen made to it, to an event database 198 (see FIG. 3). Each inboundmessage includes one or more worklist items. Therefore, the inboundmessage is added to the event database 198 by way of adding the worklistitems to the database. A worklist item is an action to be performed inresponse to an event. For example, it is contemplated that a worklistitem specifies that an alert about a patient's hypoglycemia is to beprovided to the patient's doctor.

To send outbound messages, the event handler 106 suitably monitorsworklist items in the event database 198 to determine which, if any, ofthe worklist items need an outbound message sent, determines when tosend the message based on a number of factors, discussed below, andultimately sends the message to the target user. Suitably, this isperformed using one or more rules, where the match criteria specify thecriteria for sending an outbound message and the match action specifyhow to send the outbound message. In one example, the rules include arule generating an outbound message for worklist items specifying thatan outbound message is a priority to be sent immediately for a targetuser. As another example, the rules include a rule for generating anoutbound message for any worklist items that are overdue in the sensethat an outbound message was previously sent and no response message hasbeen received within an allowed amount of time.

The event handler 106 suitably communicates with one or more of theevent source interfaces 104, the message service interface 108,subscribed event sources, and the like, using the standardized protocol105, which provides a standardized format to represent all inbound andoutbound messages. The standardized format is defined by one or moreproperties. In certain embodiments, the properties are arranged in ahierarchical structure. The properties include one or more of a uniqueevent identifier, capabilities, event properties, time and/or escalationproperties, source properties, target properties, acknowledgementproperties, and the like.

The unique event identifier uniquely identifies each event to which amessage relates. The unique event identifier allows the event handler106 to determine an association between worklist items in the eventdatabase 198 and the message. For example, a two-way event message leadsto the addition of a worklist item to the event database 198, where theworklist item is indexed using the unique event identifier of the eventmessage. A response message then identifies an association with theworklist item using the unique event identifier.

The capabilities include, for example, properties of an event source oran event target for handling event messages or response messages,respectively. For example, capabilities include one or more of supportfor one-way event communications, support for two-way eventcommunications, maintenance of local worklists, capability of providingchoices encapsulated in the messages, support of visual messages,support of audio messages, and the like.

The event properties, for example, identify one or more of the type ofevent prompting generation of the message, the severity of the event,and the like. Event types include one or more physiological events,protocol events, workflow events, system events, status events,equipment events, and the like. Status events include events describingthe status of a patient, a system, or the like and include one or moreof unit status (e.g., active orphan equipment), system status (e.g.,recorder out of paper), system health (e.g., RAID failure), qualityassurance status (e.g., patient compliance is below the target of 60%),and the like. Further, event types are used to group events. Forexample, a nurse separates protocol reminders (e.g., draw lactate) fromworkflow reminders (e.g., vitals due) on a clinical information system.Event severity distinguishes high priority events (e.g., suspect sepsis)from low priority events (e.g., no data from sensor for 30 minutes).

The time and/or escalation properties include one or more of overduetime, escalation action, escalation time, delay properties, and the likefor worklist items. Overdue time identifies the time that elapses beforea worklist item is classified as overdue. Escalation action identifieshow the worklist item is to be escalated. Escalation time identifies thetime by when an associated worklist item needs to be escalated.

The delay properties specify how long a response to a worklist item maybe delayed. The delay properties include one or more of a property forno delay, which includes, for example, a default for bed alerts, aproperty for the length of delay, a property defining the length of timean alert needs to be persistent or active in order to be processed bythe system, and the like. The length of delay ranges from 0 (implying nodelay) up to a predetermined number, such as 1440, with units of measuresuch as seconds or minutes. In certain embodiments, the property for thelength of delay subsumes the property for no delay, where a length ofdelay of 0 implicates no delay. Additionally, or alternatively, incertain embodiments, the delay properties are substitutable to apredefined unit schedule (i.e., delay for this shift). Additionally, oralternatively, in certain embodiments, the delay is settable (whenapplicable) per each level of escalation. Additionally, oralternatively, in certain embodiments, for alerts subject to time basedstandards, the event source and/or event target are not allowed toselect a delay.

The source properties typically include one or more of source type, oneor more source parameters, source location, and the like. The sourcetype identifies the type of event source (e.g., Philips Intellivue™monitor MX 800). The source parameters identifies the type of parametersthat triggered the event (e.g., blood pressure). The source locationidentifies where the source is located (e.g., Cardiology unit II).

The target properties typically include one or more of target user,target role, target alias, target application, and the like. The targetuser specifies an individual to which a message is directed (e.g., Dr.William Smith). The target role identifies the role of the target user(e.g., cardiologist on call or ICU nurse). The target alias identifiesthe target user if the name is not known (e.g., the patient's wife). Thetarget application includes be a device (e.g., the Central stationdisplay, Beeper 4434, etc.).

The acknowledgement properties suitably capture the status of a worklistitem. The acknowledgement properties include one or more of acknowledged(e.g., Dr. Smith acknowledged message), failed to send (e.g., messagedid not clear send queue), failed to receive (e.g., returned messagefrom receiving service indicates fail), failed to acknowledge (e.g.,received at end device but no user acknowledged the alert), forcedrollover (e.g., user requested rollover), forced escalation (e.g., userrequested escalation), and the like.

The standardized format divides inbound messages into one or moreworkflow items, which each include one or more properties. In certainembodiments, each workflow item is divided into one or more targets,which each include one or more properties. Additionally oralternatively, in certain embodiments, the standardized format includesa global section of one or more properties, where these properties areapplied to each of the worklist items unless overridden by properties inthe worklist items.

As should be appreciated in view of the preceding discussion, thestandardized protocol 105 allows the event sources 102 to generatemessages specifying the business logic for routing the messages. Inturn, this allows the event sources 102 that utilize the standardizedprotocol 105 to establish a mechanism for the event handler 106 to passthe messages with an end user context as part of the message and havethe end user response passed back to the event sources 102, without theevent sources 102 needing to know anything about the end user's statusor preferences.

The message service interface 108 bridges communications between theevent handler 106 and the message service 110 in circumstances when themessage service 110 lacks support for the standardized protocol 105supported by the event handler 106. The message service interface 108receives messages sent from the event handler 106 to the message service110, reformats the messages into a communications protocol supported bythe message service 110, and forwards the reformatted messages to themessage service 110. Further, the message service interface 108 receivesmessages sent from the message service 110 to the event handler 106,reformats the messages into the standardized protocol 105 supported bythe event handler 106, and forwards the reformatted messages to theevent handler 106. When the message service 110 supports thestandardized protocol 105 supported by the event handler 106, themessage service interface 108 may be unnecessary and/or removed from themessaging system 100.

The message service 110 delivers escalation messages from the eventhandler 106 to the event targets 112 and/or response messages thereto tothe event handler 106. Further, in certain embodiments, the messageservice 110 keeps track of users logged on to the message service 110.As with the event sources 102, the message service 110 can becharacterized as subscribed or unsubscribed depending upon whether itsupports the standardized protocol 105 supported by the event handler106.

The event targets 112 receive escalation messages from the event handler106 and, in some embodiments, generate and communicate response messagesto the event handler 106. Response messages, like event messages,include one or more worklist items. Typically, to generate a responsemessage, an event target presents an event message on a display and/orprompts a user of the event target to provide a response thereto via thedisplay and/or a user input device. Of interest to note, an escalationmessage for an event message may be sent to multiple event targets 112at once. The user response and ability to respond may be differentdepending on the event target. The response messages include, forexample, one or more of a unique event identifier, capabilities, eventproperties, time properties, source properties, target properties,acknowledgement properties, and the like, as discussed above. As withthe event sources 102, in some embodiments, a distinction is madebetween one-way event targets and two-way event targets. Additionally oralternatively, in some embodiments, a distinction is made betweensubscribed event targets and unsubscribed event targets.

With reference to FIG. 2, the event sources 102, in the illustratedembodiments, include one or more of monitors, such as a patient monitor102 a, clinical decision support applications, therapeutic devices, suchas a therapeutic device 102 b, clinical information systems, such as aclinical information system 102 c, and the like.

Communication units 118, 126, 134 of the event sources 102 facilitatecommunication between the event sources 102 and external devices, suchas the event handler 106 and/or the event source interfaces 104.Suitably, communication is performed by way of one or morecommunications networks. Memories 115, 123, 131 of the event sources 102store patient data and the like and/or store executable instructions forperforming one of more of the functions associated with the eventsources 102. Displays 116, 124, 132 of the event sources 102 allow theevent sources 102 to display data and/or messages for the benefit ofusers at the respective one of the event sources 102. User input devices120, 128, 136 of the event sources 102 allow users of the event sources102 to interact with the associated event source 102 and/or respond tomessages displayed on its display. Processors and/or controllers 114,122, 130 of the event sources 102 execute instructions stored on thememories to carry out the functions associated with the event sources102.

The event source interfaces 104 in the illustrated embodiments include afirst event source interface 104 a, which interfaces with multiple eventsources. Communication units 138 of the event source interfaces 104facilitate communication between an associated event source interfaceand an external device, such as the event handler 106 and the eventsource 102. Memories 142 of the event source interfaces 104 storeexecutable instructions for performing one of more of the functionsassociated with the event source interfaces 104. Processors and/orcontrollers 140 of the event source interfaces 104 execute instructionsstored on the memories to carry out the functions associated with theevent source interfaces 104. The memories 142, in some embodiments,store or buffer the data or messages from the event sources 102.

Further, each of the event source interfaces 104 suitably communicatesvia one or more communications networks. For example, in certainembodiments, an event source interface communicates with an unsubscribedevent source via a first communications network and the event handler106 via a second communications network, where the first communicationsnetwork is different than the second communications network.

The event handler 106 communicates with the event targets 112 via themessage service interface 108 and/or the message service 110, andcommunicates with the event sources 102 directly or via the event sourceinterface 104. In certain embodiments, the event handler 106additionally, or alternatively, communicates with the event targets 112directly.

The message service interface 108 in the illustrated embodimentsincludes one or more of a communications unit 144, a processor and/orcontroller 146, a memory 148, and the like. The communications unit 144facilitates communication between the message service interface 108 andan external device, such as the message service 110 and the eventhandler 106. The memory 148 stores executable instructions forperforming one of more of the functions associated with the messageservice interface 108. The processor and/or controller 146 executesinstructions stored on the memory 148 to carry out the functionsassociated with the message service interface 108.

The message service interface 108 suitably communicates via one or morecommunications networks. For example, in certain embodiments, themessage service interface 108 receives an escalation message from theevent handler 106 via a first communicate network and forward theescalation message to the message service 110 via a secondcommunications network.

The message service 110 in the illustrated embodiment includes one ormore of a communications unit 150, a processor and/or 152, a memory 154,and the like. The communications unit 150 facilitates communicationbetween the message service 110 and one or more of the message serviceinterface 108, the event handler 106, the event targets 112, and thelike. Suitably, this is by way of one or more communications networks.The memory 154 stores executable instructions for performing one of moreof the functions associated with the message service 110. The processorand/or controller 152 executes instructions stored on the memory 154 tocarry out the functions associated with message service 110.

The event targets 112 in the illustrated embodiments include one or moreof hand held devices, such as a cell phone 112 a, therapeutic devices,such as a therapeutic device 112 b, clinical information systems, suchas a clinical information system 112 c, monitors, such as a patientmonitor 112 d, clinical decision support applications, and the like.Further the event targets 112 include one or more one-way event targetsand/or one or more two-way event targets. Additionally, the eventtargets include one or more subscribed event targets and/or one or moreunsubscribed event targets, depending on whether or not the eventtargets support the standardized protocol 105.

Communication units 160, 168, 176, 184 of the event targets 112facilitate communication between the event targets 112 and externaldevices, such as the event handler 106 and the message service 110.Communications are suitably conducted using one or more communicationsnetworks. Memories 157, 165, 173, 181 of the event targets 112 store oneor more of patient data, executable instructions for performing one ofmore of the functions associated with the event targets 112, and thelike. Displays 158, 166, 174, 182 of the event targets 112 allow theevent targets 112 to display data and/or messages for the benefit ofusers of the event targets 112. User input devices 162, 170, 178, 186 ofthe event targets 112 allow users of the event targets 112 to interactwith the event targets 112 and/or respond to messages displayed on thedisplays. Processors and/or controllers 156, 164, 172, 180 of the eventtargets 112 execute instructions stored on the memories to carry out thefunctions associated with the event targets 112.

The event handler 106 illustrated in FIG. 3 includes one or more of ahospital policies database 188, a target settings database 190, anon-call database 192, a rules database 194, an event handling protocolparser 196, the event database 198, an authoring environment 202, anevent handling rules executor 200, an audit log database 204, and thelike. Although depicted with the event handler 106, the variousdatabases in some embodiments can be central, institution, or departmentwide databases that are accessed by the event handler 106.

The hospital policies database 188 includes one or more settingsallowing hospital administrators to specify hospital policy. Thesesettings, for example, let hospital administrators specify the minimumseverity level for physiological events received from the event sources102. The hospital policies are suitably applied to inbound messages viaone or more rules in the rules database 194. In certain embodiments, thehospital policies include hard policies and soft policies. Hard policiesare blocked from being modified and/or overwritten by other settings,such as target settings; whereas, soft policies may be overwritten byother settings, such as target settings.

The target settings database 190 includes one or more settings specificto a target of an inbound message. For example, the target settingsallow an individual to specify how they are contacted, such as via acell phone only. These settings are suitably applied so long as they donot conflict with hard hospital policies. Targets can include one ormore of event sources, event targets, individuals, roles, aliases,applications, devices, and the like. As with hospital policies, targetsettings are suitably applied to inbound messages via one or more rulesin the rules database 194. In certain embodiments, the target settingsare linked to preset communication profiles, such as a paging interface,central stations, and unit bound clients.

The on-call database 192 tracks those clinicians who are presentlyon-call and typically includes one or more on-call records specifyingclinicians currently on-call. In certain embodiments, the on-callrecords include the roles of clinicians. For example, the on-calldatabase 192 includes an on-call record specifying that Joe Smith iscurrently on call with oncology. One or more of the authoringenvironment 202, the message service 110, and the like may update theon-call records.

The rules database 194 includes one or more rules for verifying and/ormodifying worklist items in inbound messages and/or the event database198. The rules for verifying and/or modifying worklist items in inboundmessages are applied by the event handling protocol parser 196, and therules for verifying and/or modifying worklist items in the eventdatabase 198 are applied by the event handling rules executor 200. Asnoted above, a rule suitably includes a match criteria and a matchaction, where the match action is carried out if the match criteria ismet. A match action includes, for example, escalating a worklist item,modifying a worklist item in an inbound message and/or the eventdatabase 198, and the like.

In certain embodiments, the rules include one or more rules to verifyand/or modify worklist items on the basis of one or more specifiedtargets. These rules use the on-call database 192 to verify that anindividual specified as a target in a worklist item is on-call orreachable, and, if not, to replace the individual specified as thetarget with one who is on-call or reachable. Additionally, oralternatively, these rules use the on-call database 192 to replace atarget role specified as a target for a worklist item with an individualwho is on-call. In both cases, the target is replaced according to oneor more properties contained in the worklist item, hospital policies,target settings, and the like.

Additionally or alternatively, in certain embodiments, the rules includeone or more rules to verify and/or modify worklist items on the basis ofworklists. A worklist, for example, includes one or more tasks that needto be performed, such as providing a Pneumovax vaccine prior todischarging a critically ill patient. Worklists are comprised of variousworklist items in an inbound message and/or the event database 198.Worklists are often specific to one or more of targets in a worklistitem, such as an event source or an event target, patients, targetroles, target individuals, and the like.

Among other things, it is contemplated that the rules making use ofworklists in the illustrated embodiment can increase and/or decrease thepriority of worklist items based on the worklists. This is accomplishedthrough modification of the severity of a worklist item, the responsetime for a two-way worklist item, and the like. For example, a rulecould cause the event handling protocol parser 196 to increase anoverdue time for a worklist item in an inbound message if a targetthereof becomes overwhelmed with a more severe event. Hence, in a sense,the worklist items associated with a worklists are dynamically ranked,where this ranking is adjusted using the rules.

Additionally or alternatively, in certain embodiments, the rules includeone or more rules to verify and/or modify worklist items on the basis ofsource, such as the event sources 102 or the event targets 112. Forexample, while an interface, such as the event source interfaces 104 orthe message service interface 110, allows a target to parse a messagefrom an unsubscribed source, the message could still lack certainessential information. These rules add information and/or modifyexisting information of worklist items sent from unsubscribed sources tofill any voids that exist. Typically, these rules are only applied bythe event handling protocol parser 196.

Additionally or alternatively, in certain embodiments, the rules includeone or more rules to verify and/or modify worklist items on the basis ofworkflows. Workflows are suitably specific to events or specific totargets, such as an event source, an event target, patients, targetroles, target individuals, and the like. In some embodiments, theworkflows include state machines defining the workflows. Further, insome embodiments, the rules delay outbound messages for a worklist itemuntil an associated workflow reaches a particular state.

Additionally or alternatively, in certain embodiments, the rules includeone or more rules to verify and/or modify worklist items on the basis ofhospital policies, target settings, or the like. For example, the rulesinclude one or more rules augmenting worklist items of a particularevent type so the worklist items include a minimum severity level. Asanother example, the rules include one or more rules augmenting worklistitems directed to a target individual so as to contact said individualusing a means of communication preferred by the individual, such as viaa cell phone.

The rules database 194 further includes one or more rules for escalatingworklist items in the event database 198. These rules are applied by theevent handling rules executor 200. Escalation refers to sending anoutbound message to a target, whether it is an event target or an eventsource. For example, a rule specifies that an escalation message shouldbe provided to a second target if a first target does not acknowledge apreviously provided escalation message within 30 minutes. As anotherexample, a rule specifies that an event handler response message shouldbe communicated to an event source every 5 minutes for at most 60minutes until delivery is successful.

The event handling protocol parser 196 processes inbound messages,including event messages and/or response messages, to extract the onemore worklist items contained therein. Suitably, the event handlingprotocol parser 196 is employed to parse inbound messages in the formatof the standardized protocol 105. Therefore, a number of properties,including one or more of unique event identifier, capabilities, eventproperties, target properties, acknowledgement properties, and the like,define the worklist items.

The event handling protocol parser 196 further verifies and, whenappropriate, updates extracted worklist items. The extracted worklistitems are verified and/or modified using one or more rules from therules database 194, where the rules are applied using one or more ofhospital policies, target settings, properties of the inbound message,on-call status, worklists, workflows, other events, and the like. Theextracted and, potentially, updated worklist items are then stored inthe event database 198.

The event handling protocol parser 196 includes one or more of aprocessor 206, a communication unit 208, a memory 210, and the like. Thecommunications unit 208 in the illustrated embodiment facilitatescommunication between the event handling protocol parser 196 and otherdevices, such as the event source interfaces 104, the event sources 102,the hospital policies database 188, and the like. Communications aresuitably performed via one or more communications networks. The memory210 stores executable instructions for performing one of more of thefunctions associated with the event handling protocol parser 196. Theprocessor 206 executes instructions stored on the memory 210 to carryout the functions associated with the event handling protocol parser196.

The event database 198 stores extracted and, potentially, updatedworklist items. The worklist items are suitably defined according to thestandardized protocol 105. Therefore, the event database 198 stores oneor more of a unique event identifier, capabilities, event properties,target properties, response properties, and the like.

The authoring environment 202 allows authorized users to modify one ormore of hospital policies, target settings, and rules in the hospitalpolicies database 188, the target settings database 190, and the rulesdatabase 194, respectively. In certain embodiments, the authoringenvironment 202 further allows authorized users to modify the on-callrecords of the on-call database 192. For example, the authoringenvironment 202 allows an authorized user to change the roles ofclinicians. In other embodiments, data interfaces with externalscheduling systems are used to directly and automatically update theuser role and on-call database 192. The authoring environment 202 isalso important for generating rules to update messages from unsubscribedsources, such unsubscribed event sources, an unsubscribed messageservice, and unsubscribed event targets. This enables messages fromunsubscribed sources to be handled in the same fashion as those fromsubscribed event sources. In certain embodiments, the authoringenvironment 202 is sandboxed or locally replicated from the productionsystem so rules can be tested and verified without interfering with theactive configuration, and then activated to the production system.

A desktop computer, a computer server, and the like suitably embody theauthoring environment 202. Both distributed and localized computerservices are contemplated. The authoring environment 202 includes one ormore of a display 212, a processor and/or controller 214, acommunication unit 216, a user interface device 218, a memory 220, andthe like. The communications unit 216 facilitates communication betweenthe authoring environment 202 and other components of the event handler106, such as the hospital policies database 188, the target settingsdatabase 190, the on-call database 192, and the rules database 194.Communications are suitably performed via one or more communicationsnetworks. The memory 220 stores executable instructions for performingone of more of the functions associated with the authoring environment202. The processor and/or controller 214 executes instructions stored onthe memory 220 to carry out the functions associated with the authoringenvironment 202. The user input device 218 and the display 212 allowusers of the authoring environment 202 to interact with the constituentdatabase of the event handler 106.

The event handling rules executor 200 queries the event database 198 todetermine if there are worklist items that need to be acted upon usingthe rules in the rules database 194. A worklist item needs to be actedupon if an outbound messages needs to be sent therefor. For example, ifa worklist item specifies it requires immediate delivery to a target,the worklist needs to be acted upon. Suitably, the event handling rulesexecutor 200 checks for worklist items that need to be acted upon inregular intervals. However, other trigger events are contemplated. Forexample, in certain embodiments, each worklist item is appropriated itsown timer to trigger a check of the worklist item.

When the event handling rules executor 200 identifies one or moreworklist items that need to be acted upon, it verifies the worklistitems and generates an outbound message for the worklist items in thestandardized format 105, using one or more rules in the rules database194. Outbound messages include escalation messages and event handlerresponse messages. These rules suitably verify and/or generate theworklist items on the basis of one or more of hospital policies, targetsettings, properties of the inbound message, on-call status, worklists,workflows, other events, and the like. The generated outbound messagesare then sent to the event target or event source specified by theworklist item, depending upon the source of the worklist items (i.e.,event message or response message).

After an outbound message is sent for a worklist item, the eventhandling rules executor 200 removes the worklist item from the eventdatabase 198 or updates it in the event database 198 to reflect that anoutbound message was sent. The worklist item is suitably removed fromthe event database 198 when the tasks associated therewith arecompleted, so as to maintain the event database 198 with only thepending worklist items. A worklist item for a one-way event message issuitably completed when an escalation message is delivered to the eventtarget, and a worklist item for a two-way event message is suitablycompleted when a response message to the event message is delivered tothe event source of the event message. Typically, response messages areone-way.

The event handling rules executor 200 includes one or more of aprocessor and/or controller 222, a communication unit 224, a memory 226,and the like. The communications unit 224 facilitates communicationbetween the event handling rules executor 200 and other devices, such asthe message service interface 108, the event targets 112, the rulesdatabase 194, and the like. Communications are suitably performed viaone or more communications networks. The memory 226 stores executableinstructions for performing one of more of the functions associated withthe event handling rules executor 200. The processor and/or controller222 executes instructions stored on the memory 226 to carry out thefunctions associated with the event handling protocol parser 200.

The audit log database 204 maintains a log of the steps taken by theevent handling protocol parser 196 and the event handing rules executor200. Suitably, all steps are logged, but more sophisticated loggingschemes are amenable. Logging all steps allows authorized users toreconstruct past event messages that have been removed from the eventdatabase 198.

With reference to FIG. 4, an example of an event message 400 generatedby, for example, a patient monitor is illustrated. The event message 400employs the standardized protocol 105, described of above, and isdirected to multiple targets. For example, the event message 400 isdirected to users a and b, which need to acknowledge an escalationmessage at a severity level “4” within 30 seconds of delivery;otherwise, the event message 400 is escalated for immediate notificationat a severity level “3” to user d. The event message 400 is furtherdirected to user f at a severity level “3” only if the event persistsmore than 2 minutes. User f would have to acknowledge the alert within60 seconds, so as not to be notified again.

With reference to FIG. 5, a method 500 of routing clinical messagesusing the event handler 106 of FIG. 1 is provided. A determination 502is made as to whether an inbound message, either an event message or aresponse message, is present. If no inbound message is present, theevent database 198 is queried 512 and a determination 514 is made as towhether a worklist item therein needs to be acted upon. If an inboundmessage is present, it is received 504 in the standardized format 105.Worklist items contained in the inbound message are extracted 506. Theextracted worklist items are verified and, possibly, modified 508 usingone or more rules in the rules database 194. These rules are, forexample, based on one or more of hospital policies, target settings,properties of the event messages, on-call status, worklists, workflows,other events, and the like. The verified and, possibly, modified rulesare then stored 510 in the event database 198. The event database 198 isqueried 512 and a determination 514 is made as to whether a worklistitem therein needs to be acted upon. This determination is suitably madeusing one or more rules in the rules database 194. If no worklist itemsare determined to need action, the determination as to whether aninbound message is present 502 is repeated. Suitably, a delay isinterposed. If a work list item is identified that needs action, theworklist item is verified 516 against one or more rules in the rulesdatabase 194 and an outbound message, either an escalation message or anevent handler response message, is generated 518 and sent 520 in thestandardized format 105 to a target user identified by the rules. Theworklist item is then updated or deleted 522. Method 500 then startsagain with determination 502.

With reference to FIG. 6, a method 600 of escalating worklist itemsbased on target availability is provided. The method 600 is oneembodiment of the method 500 and is suitably performed by the processors206, 214, 222 of the event handler 106. As will be seen hereafter, themethod 600 advantageously allows worklist items for a location, device,or patient, such as a bed, to be more quickly serviced by refrainingfrom alerting targets known to be servicing higher priority worklistitems. Further, the method 600 advantageously reduces alarm fatigue anddistraction on the part of the targets, thereby improving overallsafety. For ease of discussion, the method 600 is limited to a singleworklist item. However, it is to be appreciated it is equally amenableto a plurality of worklist items and event messages.

The method 600 presupposes one or more of the databases 188, 190, 192,194, 198, 204 of the event handler 106 cooperate to define escalationsequences and assignments thereof for locations, devices, or patients ofan institution employing the event handler 106. Each of the escalationsequences includes one or more escalation levels and the orderescalation advances through the escalation levels. For example, alocation, device, or patient includes an escalation sequence identifyinga first escalation level of primary targets and a second escalationlevel of secondary targets, where escalation proceeds from the firstescalation level to the second escalation level.

The method 600 further presupposes one or more of the databases 188,190, 192, 194, 198, 204 of the event handler 106 cooperate to definelocation, device, or patient assignments for targets, such as users,groups, devices, and so on, and escalation level assignments for thelocation, device, or patient assignments. For example, a first user isassigned to a first escalation level of a patient, and a second user isassigned to a second escalation level of the patient. Stateddifferently, the first user is assigned primary responsibility for thepatient, and the second user is assigned secondary responsibility forthe patient.

A determination 602 is made as to whether an event message, including aworklist item, for a location, device, or patient is present. If noevent message is presented, a determination 610 is made as to whetherescalation is needed, as discussed below. Otherwise, the event messageis received 604 from an event source 102, such as a patient monitor,optionally in the standardized format. The location, device, or patientis assigned an escalation sequence including a plurality of escalationlevels, each escalation level including a target, such as a user, adevice, an application, a group, and so on. As noted above, escalationsequence and assignments are suitably defined through cooperation of oneor more of the databases 188, 190, 192, 194, 198, 204 of the eventhandler 106. The worklist item includes a current position within theescalation sequence. The current position is initially the firstescalation level of the escalation sequence, but advances withescalation.

After receiving 604 the worklist item, it is optionally updated 606(i.e., verified and modified) using one or more rules in the rulesdatabase 194. These rules are, for example, based on one or more ofhospital policies, target settings, properties of the event messages,on-call status, worklists, workflows, other worklist items, and thelike. For more detail, attention is directed to the foregoing discussionof the event handler 106. The verified and, possibly, modified worklistitem is then stored 608 in the event database 198.

The determination 610 is next made as to whether a worklist item needsescalation (i.e., that an escalation message needs to be sent) byquerying the event database 198 and checking the worklist item againstone or more rules in the rules database 194. For example, a rule mayspecify a first escalation message is to be sent immediately uponreceipt of the worklist item, and another rule may specify a secondescalation message is to be sent after a predetermined period of timelapses without receipt of any acceptance and/or acknowledgment of thefirst escalation message. As another example, a rule may specify that ifa previously sent escalation message for the worklist item is rejectedby the target, then escalation is in order. Typically, the eventdatabase 198 is queried periodically, but it is also contemplated thatthe event database 198 is queried continuously or upon the happening ofan event.

In some embodiments, when the worklist item is to be escalated, adetermination 612 is made as to whether a target of the first escalationlevel of the escalation sequence previously rejected a worklist itemwith a priority level higher or equal to a priority level of theworklist item to be escalated. Optionally, the previous rejection islimited to a rejection within a predetermined period of time from thedetermination 612. It is contemplated that the predetermined period canbe specific to the target and, optionally, specified in the targetsettings database 190. When such a rejection has not been made and anescalation message for the worklist item has not been sent to thetarget, an escalation message is generated 614 and communicated 616 tothe target of the first escalation level. The determination 610 ofwhether a worklist item is to be escalated is then repeated after thedetermination 602 as to whether a new event message is present is made.

When it is determined the worklist item is to be escalated and, ifapplicable, the rejection has been made, the event handler identifies618 a next escalation level of the location, device, or patient. Thisincludes retrieving the escalation sequence for the location, device, orpatient corresponding to the event message, as well as the location,device, or patient assignments for the targets and escalation levelassignments for the location, device, or patient assignments, from oneor more of the databases 188, 190, 192, 194, 198, 204 of the eventhandler 106. Advantageously, by retrieving the assignments for eachescalation, changes in escalation sequences and/or targets assigned toescalation levels (e.g., due to schedule changes or shift changes) aretaken in to account. When an escalation sequence does not exist, adefault escalation sequence including at least one escalation level canbe employed. The escalation level can include, for example, supervisorsor managers of the institution.

Beginning with the current position within the escalation sequence, theescalation levels of the retrieved escalation sequence are then steppedthrough in order until the end of the escalation sequence is reached oran escalation level with a target that is not already servicing a higherand/or equal priority worklist item is found. While stepping through theescalation sequence, the current position is updated. In someembodiments, the next escalation level includes at least one target notalready servicing a higher priority and/or equal priority worklist itemand not already servicing a worklist item exceeding a predeterminedpriority threshold. For example, if a primary target is servicing asevere, but not life critical, worklist item and a life criticalworklist item for the primary target is received, the received worklistitem can be escalated to a secondary target.

A target is deemed to be servicing a worklist item when a messageaccepting and/or acknowledging the worklist item is received from thetarget. Further, a target is deemed to have finished servicing aworklist item upon receipt of a message to that effect and/or after apredetermined period of time from the acceptance and/or acknowledgementhas lapsed. In some embodiments, the predetermined period is specific tothe target and, optionally, specified in the target settings database190. Further, in some embodiments, a target is deemed to have finishedservicing a worklist item upon receipt of a message indicating thetarget wishes to pass the worklist item to another target via theescalation procedure. For example, a primary target for a location,device, or patient receives a high priority worklist item for alocation, device, or patient and failed to finish a low priorityworklist item for another location, device, or patient for which it isthe primary target. The low priority worklist item can be passed to asecondary target. The event handler 106 suitably tracks whether targetsare servicing worklist items by maintaining records thereof in one ofthe databases 188, 190, 192, 194, 198, 204 and/or the memories 210, 226,220 of the event handler 106.

When the end of the escalation sequence is reached, a default escalationsequence can be employed. Otherwise, the worklist item is verified 620against one or more rules in the rules database 194 and an escalationmessage for the worklist item is generated 622 and communicated 624 tothe identified target via an event target 112. Suitably the escalationmessage is sent in the standardized format. The worklist item is thendeleted or updated 626 to reflect the escalation message was sent, andthe determination 602 is made as to whether new event messages arepresent. In some embodiments, lower priority worklist items theidentified target is servicing are escalated in response to theidentified target servicing the worklist item. It is contemplated thatthis escalation can further require receipt of a message from theidentified target indicating the at least one identified target wishesto pass the lower priority worklist items to other targets via theescalation procedure. Further, it is contemplated that escalation can beto a target, such as a supervisor, chosen by the identified target.

In some embodiments, priorities of worklist items being serviced by theidentified target are compared against a predetermined prioritythreshold. Notably, these worklist items are of a lower priority thanthe received worklist item because the identified target would otherwisenot receive an escalation message for the worklist item. In response tothese worklist items exceeding the predetermined priority threshold, theescalation message is also communicated to targets of the escalationlevel following the next escalation level. For example, if a target wassent an escalation message for a serious, but not critical worklistitem, and a life critical worklist item is received for the target, anescalation message for the life critical worklist item can be sent tothe target, as well as another target in the higher escalation level.

With reference to FIG. 7, a method 700 of self-describing andcommunicating event information to the event handler 106 is provided.One of the event source interfaces 104 and/or the message serviceinterface 108 suitably performs the method 700. Event information, suchas a notice of an event or a user response to an event, is received 702from, for example, one of the event sources 102 and/or the messageservice 110. A message is generated 704 using the standardized protocol105. The message includes the event information and one or more worklistitems, represented using one or more standardized message properties.The worklist items specify to whom the message is directed and how themessage should be escalated by the event handler 106. The message isthen communicated 706 to the event handler 106.

Each of the databases described herein, such as the hospital policiesdatabase 188, suitably include a computer database, where the computerdatabase is embodied by a single computer, distributed across aplurality of computers, or the like. Further, each of the databasessuitably stores data in a structured manner facilitating recall andaccess to such data. Further, as used herein, a memory includes one ormore of a non-transient computer readable medium; a magnetic disk orother magnetic storage medium; an optical disk or other optical storagemedium; a random access memory (RAM), read-only memory (ROM), or otherelectronic memory device or chip or set of operatively interconnectedchips; an Internet server from which the stored instructions may beretrieved via the Internet or a local area network; or so forth.Further, as used herein, a controller includes one or more of amicroprocessor, a microcontroller, a graphic processing unit (GPU), anapplication-specific integrated circuit (ASIC), a field-programmablegate array (FPGA), and the like; a communications network includes oneor more of the Internet, a local area network, a wide area network, awireless network, a wired network, a cellular network, a data bus, suchas USB and I2C, and the like; a user input device includes one or moreof a mouse, a keyboard, a touch screen display, one or more buttons, oneor more switches, one or more toggles, voice driven interaction, and thelike; and a display includes one or more of a LCD display, an LEDdisplay, a plasma display, a projection display, a touch screen display,and the like.

The teachings of the present disclosure may be deployed in any clinicalIT infrastructure (both in-patient and out-patient), where there aredevices (e.g., monitors) and information systems (e.g., ICU informationsystems or healthcare information systems) that generate alerts orreminders. In systems that are able to expose clinical worklists, thepresent disclosure can extract that information and consolidate andmaintain it.

Additionally, the teachings of the present disclosure may be deployedoutside of healthcare. For example, they may be employed for use inhospitality management, such as room service or food service. As anotherexample, they may be employed for use with avionics and marinemultisystem event management where workflow consolidation acrossmultiple systems is needed.

The invention has been described with reference to the preferredembodiments. Modifications and alterations may occur to others uponreading and understanding the preceding detailed description. It isintended that the invention be constructed as including all suchmodifications and alterations insofar as they come within the scope ofthe appended claims or the equivalents thereof.

Having thus described the preferred embodiments, the invention is nowclaimed to be:
 1. A messaging system for routing clinical messages, saidmessaging system comprising: an event handler comprising: a memory withexecutable instructions stored thereon; and a processor configured toaccess said memory to execute said instructions and to: receive one ormore inbound messages, including one or more worklist items, from one ormore event sources; store the worklist items in an event database; and,generate and communicate outbound messages for one or more worklistitems in the event database that need to be acted upon, as determined byone or more rules; and a standardized protocol to represent the inboundmessages and the outbound messages; wherein the event handler verifiesand/or modifies the worklist items of the inbound messages using one ormore rules, wherein the rules are based on one or more of hospitalpolicies, target settings, properties of the inbound messages, on-callstatus, worklists, and workflows.
 2. The messaging system according toclaim 1, wherein the event handler determines the worklist items thatneed to be acted upon using one or more rules, wherein the rules includeone or more rules based on worklists implicit in the event databaseand/or workflows.
 3. The messaging system according to claim 1, whereinthe event handler updates and/or deletes worklist items in the eventdatabase for which outbound messages were generated and communicated. 4.The messaging system according to claim 1, wherein the inbound messagesinclude properties specifying when corresponding outbound messages areto be sent.
 5. The messaging system according to claim 1, wherein theevent handler is configured to: receive a worklist item for a location,device, or patient from the inbound messages, wherein the location,device, or patient includes an escalation sequence of escalation levels,each escalation level including a target; determine whether the worklistitem is to be escalated using the rules; in response to determining theworklist item is to be escalated, identify a next escalation level ofthe location, device, or patient, the next escalation level includingonly target(s) not already servicing higher and/or equal priorityworklist items; and, generate and communicate an outbound message forthe worklist item to the identified target.
 6. The messaging systemaccording to claim 5, wherein the next escalation level is identified bystepping through escalation levels of the escalation sequence until anescalation level including a target not already servicing higher and/orequal priority worklist items is found.
 7. A method of routing clinicalmessages, said method performed by one or more processors preprogrammedto perform said method, said method comprising: receiving one or moreinbound messages in a standardized protocol from one or more eventsources, said inbound messages including one or more worklist items;storing the worklist items in an event database; generating andcommunicating outbound messages in the standardized protocol for one ormore worklist items in the event database that need to be acted upon, asdetermined by one or more rules; receiving a worklist item for alocation, device, or patient from the inbound messages, wherein thelocation, device, or patient includes an escalation sequence ofescalation levels, each escalation level including a target; determiningwhether the worklist item is to be escalated using the rules; inresponse to determining the worklist item is to be escalated,identifying a next escalation level of the location, device, or patient,the next escalation level including only target(s) not already servicinghigher and/or equal priority worklist items; and generating andcommunicating an outbound message for the worklist item to theidentified target.
 8. The method according to claim 7, furtherincluding: verifying and/or modifying the worklist items of the inboundmessages using one or more rules, wherein the rules are based on one ormore of hospital policies, target settings, properties of the inboundmessages, on-call status, worklists, and workflows.
 9. The methodaccording to claim 7, wherein the generation of the outbound messagesuse one or more rules based on one or more of hospital policies, targetsettings, properties of the inbound messages, on-call status, worklists,and workflows.
 10. The method according to claim 7, wherein theidentifying includes: stepping through escalation levels of theescalation sequence until an escalation level including a target notalready servicing higher and/or equal priority worklist items is found.11. A computer readable medium carrying software which controls one ormore processors to perform the method according to claim
 8. 12. A methodof self-describing and communicating event information to an eventhandler, comprising one or more processors, said method performed by oneor more processors preprogrammed to perform the method, said methodcomprising: receiving event information including a notice of an eventand/or a user response to the notice of an event; generating a messageusing a standardized protocol, wherein the message includes the eventinformation and one or more worklist items, represented using one ormore standardized message properties, wherein the worklist items specifyto whom the message is directed and how the message should be routed bythe event handler; and, communicating the message to an event handler;wherein the event handler verifies and/or modifies the worklist items ofthe inbound messages using one or more rules, wherein the rules arebased on one or more of hospital policies, target settings, propertiesof the inbound messages, on-call status, worklists, and workflows. 13.The method according to claim 12, wherein each of the worklist itemsspecify one or more targets for all or a subset of the eventinformation.
 14. The method according to claim 12, wherein the messageincludes business logic for how all or a subset of the event informationshould be routed.
 15. The method according to claim 12, furtherincluding: receiving second event information including a user responseto the notice of the event; generating a second message using thestandardized protocol, the second message including the second eventinformation and specifying to whom the second message is directed andhow the second message should be routed by the event handler; and,communicating the second message to the event handler.